2017 Funders for Reproductive Equity Annual Meeting
Registration Policy: You must be a staff person, board member, or trustee of a grantmaking institution or affinity group to attend the Funders Network Annual Meeting. (Consultants are not eligible to attend.)
Registrant's First Name (*)
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Registrant's Last Name (*)
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Title
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Foundation
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Address 1 (*)
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Address 2
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City (*)
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State (*)
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Zip Code (*)
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Telephone (*)
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Mobile Phone
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Fax
Email Address (*)
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Please check one:
Registrant's Position



Affinity Group
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Attendee Names (if more than one)
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Emergency Contact Information
Name
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Relationship
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Contact's Phone
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Contact Phone alt.
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Please tell us what you need, including any mobility, audio, or visual access requirements, to fully participate in the conference. If filling out the form for more than one attendee, please indicate names requiring special needs.
Accessibility
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Please indicate if you have any dietary restrictions. If filling out the form for more than one attendee, please indicate names and restrictions.
Dietary Restrictions
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Site Visits - Tue., Oct. 17, 9:45 am - 6pm - $250/person includes lunch
Nbr. Registrations/Attendees for Site Visits
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Attendee Name(s) - Site Visit
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Working Groups, Tue. Oct 17 and Wed, Oct 18 (for members only; registration required)
Please check appropriate boxes if attending any of the following events. If this form concerns more than one registrant, please indicate all attendee names.
Tue., Oct 17 Working Groups
SLWG breakfast meeting, (Members Only)
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Attendee Name(s) - SLWG workshop
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Wed., Oct 18 Working Groups
Membership-wide Gathering (Members Only)
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Attendee Name(s) - Mbrs Gathering
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Youth Leadership and Engagement Working Group (Members Only)
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Attendee Name(s) - Youth Ldrship Mtg
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International Funders WG (Members Only)
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Attendee Name(s) - Int'l Funders WG Mtg.
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Nbr. Registrations/Attendees for the Conference itself (*)
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Registration Cost (ea.) (*)
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(Philanthropy-serving organizations can register at member rate)
Payment Type (*)
Please choose one.
We strongly encourage all credit card customers to use the "Online" option. If "Online" is chosen, you will be redirected to the website of the Funders Network's chosen payment processor, Payjunction, for secure (SSL) credit card processing.
*If paying by check, please mail to: Funders for Reproductive Equity, P.O. Box 750, Rockville, MD, 20848-0750
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A confirmation email of this registration will be sent to the email address that was entered.